Selective, conservative operations for cancer of the breast

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One of the common questions that surgeons are asking one another is, “What operation are you doing now for breast cancer?” The answer usually is, “I’m still doing radical mastectomies,” or, “I’ve switched to the modified radical mastectomy.” Rarely do surgeons admit that one can be selective in choosing an operation for breast cancer. The following quote from a paper by Urban and Castro summarizes our view at the Cleveland Clinic: “The scope of the primary operative procedure should be correlated with the extent of the clinical pathologic setting of disease in each individual patient with the aim of removing all disease present while interfering least with appearance and function.”1 We believe that surgeons have a choice in operative procedures for the potential cure of breast cancer based on the extent of the disease, the location and size of the primary lesion, and their own knowledge and philosophy about the treatment of primary breast cancer.

The operations available for the treatment of breast cancer include the extended radical mastectomy, the standard radical mastectomy, modified radical mastectomy, total mastectomy with axillary biopsy and, finally, partial mastectomy with or without axillary biopsy. All of these operative procedures have the capacity to remove all local and regional disease. If the tumor has metastasized and become systemic, then adjuvant therapy is advisable.

There are two aspects to the surgeon’s choice of operation. First, concerning the breast, is it always necessary to remove all of it, or are there small, “early” lesions which may be. . .



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